Testicular Cancer

Risk Factors

The American Cancer Society defines a risk factor is anything that increases a person's chance of getting a disease such as cancer. According to ACS, different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer, and smoking is a risk factor for lung cancer. According to the American Cancer Society, scientists have found a few risk factors that make a man more likely to develop testicular cancer. Even if a man does exhibit one or more risk factors for this disease, it is impossible to know for sure how much that risk factor contributes to developing the cancer. Also, most men with testicular cancer do not have any of the known risk factors.

This cancer is not common; a man's lifetime chance of developing testicular cancer is about 1 in 300. A small increase in risk still makes the chance of ever getting it low, and the risk of dying from this cancer is 1 in 5,000.

Age: Most testicular cancers occur in younger men between the ages of 15 and 50. But this cancer can affect males of any age, including infants and elderly men.

Cryptorchidism: The main risk factor for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This term comes from the Greek words kryptos, meaning hidden, and orchis, meaning testicle. In a fetus, the testicles normally develop inside the abdomen and descend into the scrotum before birth. In about 3% of boys, however, the testicles do not make this descent. Sometimes the testicle remains in the abdomen; in other cases, the testicle starts to descend but remains stuck in the groin area.

About 14% of cases of testicular cancer occur in men with a history of cryptorchidism. The risk of testicular cancer is somewhat higher for men with a testicle positioned in the abdomen as opposed to one that has descended at least partway. In men with a history of cryptorchidism, most cancers develop in the undescended testicle, but up to 25% of cases occur in the normally descended testicle. Based on these observations, some doctors conclude that cryptorchidism is not the direct cause of testicular cancer but that some other disorder is responsible for increasing the testicular cancer risk and preventing normal positioning of one or both testicles.

Most cryptorchid testicles eventually descend on their own in the child's first year. Sometimes a surgical procedure known as orchiopexy is necessary to bring the testicle down into the scrotum. Some experts believe that performing orchiopexy before puberty may reduce the risk of developing certain types of germ cell tumors.

Family history: A family history of testicular cancer increases the risk. If one man has the disease, there is an increased risk that one or more of his brothers will also develop it. However, very few cases of testicular cancer are actually found to occur in families, so that most men are unlikely to pass this disorder on to their children.

Occupational risks: A recent study found that nonseminoma germ cell tumors occur more often among men with certain occupations (miners, oil and gas workers, leather workers, food and beverage processing workers, janitors, firefighters, and utility workers). However, other studies have failed to identify those specific occupations as being risk factors for testicular cancer. A connection between these jobs and testicular cancer must be confirmed in other studies before concluding that they represent a significant risk.

Multiple atypical nevi: Two recent studies have shown that an unusual condition, in which multiple pigmented spots or moles are found particularly on the back, chest, abdomen and face, is associated with an increased risk of developing testicular cancer. This condition also increases the risk for a form of skin cancer called melanoma, and it has been shown that patients cured of testicular cancer have an increased risk of developing a melanoma later in life.

Injury: There is no convincing evidence that an injury to the testicles increases the risk of developing cancer. It is known that males with an enlarged testicle (containing a tumor) will sometimes be injured (because the testis is positioned more prominently), which then leads to the diagnosis.

HIV infection: Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.

Carcinoma in situ: This condition does not produce a mass or cause any symptoms. Carcinoma in situ (CIS) in the testicles often progresses to cancer. In some cases, CIS is detected in men who undergo a testicular biopsy during medical evaluation of infertility or have a testicle removed because of cryptorchidism. As noted previously, the criteria to make this diagnosis are controversial, and the figures for diagnosis and progression to cancer are lower in the USA than in parts of Europe.

Cancer of the other testicle: A history of testicular cancer is another risk factor. Men who have been cured of cancer in one testicle have an increased risk (about 3% to 4%) of eventually developing cancer in the other testicle.

Race and ethnicity: The risk of testicular cancer among white American men is about 5-10 times that of African-American men and more than twice that of Asian-American men. The risk for Hispanics falls between that of Asians and non-Hispanic whites. The reason for this difference is not known. The testicular cancer rate has more than doubled among white Americans in the past 40 years but has not changed for African-Americans. Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among African and Asian men.

Maternal hormone use: Although men whose mothers took the synthetic estrogen diethylstilbestrol (DES) during pregnancy (at a time when this was prescribed to avoid a threatened miscarriage) have an increased risk of certain congenital (present at birth) reproductive system malformations, there is still controversy regarding preliminary evidence from one study which showed that DES exposure increases a man's risk for developing testicular cancer.

Body size: A recent study from Sweden found that body size was a risk factor; the highest risk was seen in tall, slim men. Because it is such an uncommon disease, the health benefits of being slim, however, outweigh any concern about testicular cancer.

Vasectomy: Some earlier studies raised the possibility that vasectomy (an operation to produce sterility) might increase the risk for testicular cancer. However, recent studies have not found any increased risk among men who have had this operation.

Support & Information

Cancer Research UK
www.cancerhelp.org.uk
Learn all about testicular cancer, symptoms, risks and causes, diagnosing testicular cancer, treating testicular cancer, living with the disease, and how to get help and support.


Everyman: Action against Male Cancer
www.icr.ac.uk/everyman/
A complete site on testicular cancer (as well as prostate cancer), how common it is among males, diagnosis and treatment for this disease, self-examination, as well as the recovery process.


C-Cancer.com: Testicular Cancer Information and Support
www.tc-cancer.com
Provides education and support for patients with testicular cancer and their family members.


Memorial Sloan-Kettering Cancer Center: Testicular Cancer
www.mskcc.org/mskcc/html/445.cfm
Information about testicular cancer including the risk factors, diagnosis, treatment and after treatment.


The National Cancer Institute: Testicular Cancer
www.cancerlinksusa.com
Information about the symptoms, diagnosis, treatment, follow up care after surgery, and support for the cancer patients and their families.